Does preoperative MIBI scanning lead to improved outcomes in patients undergoing abdominal aortic aneurysm surgery?

Dipyridamole sestamibi nuclear scanning (MIBI) is a commonly used test to s creen for cardiac disease in patients undergoing elective abdominal aortic aneurysm (AAA) surgery. However, its routine use for all patients is contro versial. The purpose of this study was to determine whether MIBI scanning c ould identify high-risk patients and lead to decreased myocardial infarctio n (MI) and cardiac death when compared with patients who did not receive MI BI scanning preoperatively. The authors reviewed 212 consecutive patients u ndergoing elective AAA repair between January 1990 and December 1993. Data regarding preoperative cardiac status, MIBI scan results, and cardiovascula r outcomes were collected. During this period, 92 patients had MIBI scans p reoperatively while 120 patients underwent AAA surgery without MIBI scannin g. The average ages for these two groups were 70 +/-8 is and 71 +/-9 years, respectively. The frequency of coronary artery disease, angina, and previo us MI in the MIBI group was 47%, 26%, and 29%, respectively. In the non-MIB I group, these frequencies were 39%, 23%, and 28%, respectively. Eleven pat ients were identified in the MIBI group to have moderate or large reversibl e defects. Of these, five underwent cardiac revascularization with no morbi dity. The frequency of postoperative MI and death for the MIBI group was 1. 1% (1/92) and 0%, respectively. In the non-MIBI group, it was 3.3% (4/120) and 1.7% (2/120), respectively (p=0.54). Preoperative MIBI scanning identif ied high-risk patients for AAA surgery. Following coronary revascularizatio n for these high-risk patients, the overall MI and mortality rates were sim ilar to those in patients who did not receive MIBI preoperatively.